Part of the DHIS2 and the Global Covid-19 Response DAC2021 Session: Tuesday 22nd June 13:00
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Standardizing DHIS2 for COVID-19 vaccine data management through packages to improve reporting: Lessons learned from Sierra Leone.
Magoba Bridget, Informatics specialist working with African Field Epidemiology Network (AFENET) Sierra Leone.
Background
Sierra Leone detected the first case of COVID-19 in March 2020, by then, the country had an electronic case-based disease surveillance system (eCBDS) set up on DHIS2 and partially rolled out to four districts covering about 30% of total health facilities. This was an opportunity to expand the use of the system to other districts and health facilities for reporting COVID-19 cases across the Country. Currently, eCBDS is rolled out to all districts countrywide with over 1400 public health facilities and 4 public health laboratories using it for real time reporting.
Methodology
Leveraging on the existing capacities and resources, the Vaccine Technical Working Group within the COVID-19 Incident Management Command adapted the World Health Organization (WHO) COVID-19 vaccine package developed in collaboration with University of Oslo. The United States Centers for Disease Control and Prevention (CDC) working with implementing partners supported the Ministry of Health and Sanitation (MoHS) to customize the DHIS2 COVID-19 vaccine package as its national system for managing COVID-19 vaccination data. The vaccine tracking system was integrated with the eCBDS to leverage on some of the established functionalities. The vaccine tracking system is accessible via web and mobile platforms. Vaccination sites use these platforms to capture person registration information, vaccine information and any mild or acute adverse events following immunization (AEFI) to a centrally hosted database. Sierra Leone customized the AEFI form as a stage within the vaccine registry tracker program to link the individual to the vaccine information. The system also tracks vaccine delivery, doses administered, schedule appointments for next dose, send appointment reminders through SMS, report any adverse events, track missed appointments and stock monitoring. We evaluated user interaction and continuously improved the system by conducting usability tests and training of the vaccination teams as well as simulation exercises. Real-life scenarios were used during the regional training to allow participants align system capabilities to the vaccination exercise.
Achievements
Currently the system is deployed in all 16 districts comprising of 36 static and 16 mobile sites which were established to reach the vulnerable groups to increase vaccine uptake in the communities across the country. Each vaccination site has a data entry clerk in charge of electronic data capture using an android tablet, a district data officer capacitated through training and mentorship to troubleshoot common technical issues encountered using DHIS2 capture android application and to perform simple analysis for district level decision making. A month into the vaccination exercise, users faced several technical challenges, these were resolved through conducting zoom calls, recording videos on data capture and analysis procedures for their reference. There is standby continuous remote support and on-site visits provided periodically to troubleshoot more complex challenges with the system. Paper based data collection is maintained as a data quality measure. Two months into the vaccination process, 95% of the people vaccinated were captured using the electronic tool. Also, by 3 weeksâ time, vaccines who were due for second dose were easily tracked in the system using EPI unique IDs to capture second dose data. Appointment reminders are sent to individuals who are eligible for second dose, and using data from 3rd week after vaccination roll out, about 30% of eligible individuals returned for 2nd dose.
Challenges
Slow capture of data (about 92%) and no AEFI cases captured in the system, high resource required to sustain the system in terms of internet data bundles for data submission, mobile devices among others.
Data use
An interactive dashboard is established at the Expanded Program for Immunization (EPI) to track vaccine uptake, number of doses administered daily, vaccine stock monitoring and vaccine coverage in the Country.
